Treatment of Cutaneous or Mucosal Leishmaniasis with Concurrent HIV/AIDS
This protocol covers the management of cutaneous or mucosal leishmaniasis (CL/ML) in patients with concurrent HIV/AIDS coinfection who show no evidence of visceral involvement and are moderately to severely immunosuppressed.
Clinical Scenario
Patients with CL/ML and concurrent HIV/AIDS — particularly those with CD4+ T-lymphocyte counts below 200–350 cells/mm³ — face increased risk for suboptimal therapeutic responses, posttreatment relapses, and potential cutaneous, mucosal, or visceral dissemination. Systemic treatment is indicated in this setting.
Treatment Approach (Partial Overview)
Systemic antileishmanial therapy is recommended for this population. The approach draws on regimens used in comparable immunocompetent patients, with careful consideration of the potential for drug interactions and toxicity in the HIV/AIDS-coinfected host. Multiple systemic options are available; the complete selection and all treatment parameters are detailed in the full protocol.
Clinical Targets
By 4–6 weeks after treatment, lesion size should have decreased by more than 50%, ulcerative lesions should be reepithelializing, and no new lesions should be appearing. Full reepithelialisation and clinical healing of ulcerative lesions are generally expected by approximately 3 months after treatment.
References
DOI: 10.1093/cid/ciw670
In HIV/AIDS-associated CL/ML, systemic antileishmanial therapy is recommended, particularly in persons who are moderately to severely immunosuppressed (eg, have CD4+ T-lymphocyte counts <200–350 cells/mm³), who may be at increased risk for suboptimal therapeutic responses, for posttreatment relapses, and for cutaneous, mucosal, or visceral dissemination.
The systemic regimens used for CL/ML in otherwise comparable immunocompetent persons typically are recommended for the initial treatment of coinfected persons, taking into account the potentials for drug interactions and toxicity (Tables 3 and 4).
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